The scale and the gender dimension of nutrition in India shows that while there is economic growth of nearly 10 per cent annually, rates of child undernutrition remain very high. According to NFHS-3, 48 per cent of children under the age of five, are stunted due to chronic undernutrition, with 70 per cent being anemic.
The nutrition situation of children is largely due to the situation of women. NFHS-3 indicates that 36 per cent of Indian women are chronically undernourished and 55 per cent are anemic. Recent data form Bihar and Madhya Pradesh shows that girls represent up to 68 per cent of the children admitted to programmes for the severely malnourished.
Child undernutrition is very much a matter of gender for three main reasons:
1. It affects women more than it affects men due to the specific nutrition needs of women during adolescence, pregnancy, and lactation;
2. Widespread nutrition deprivation among women perpetuates an inter-generational cycle of nutrition deprivation in children. Undernourished girls grow up to become undernourished women who give birth to a new generation of undernourished children;
3. Women are given the responsibility – but often not the means (empowerment) – to ensure optimal nutrition for their children. A recent study in Andhra Pradesh shows that women with higher autonomy (both financial and physical, for example – the freedom to go to the market) are less likely to have stunted children.
The consequences of the problem:
This inter-generational cycle of undernutrition transmitted from mothers to children greatly impacts on India’s present and future. Undernourished children are much more likely to suffer from infection and die from common childhood illnesses (diarrhea, pneumonia, measles, malaria) than well nourished children.
According to recent estimates, more than a third of all deaths in children aged five years or younger is attributable to undernutrition.
Undernutrition puts women at a greater risk of pregnancy-related complications and death (obstructed labor and hemorrhage).
Undernourished boys and girls do not perform as well in school as compared to their well-nourished peers, and as adults they are less productive and make lower wages.
Widespread child undernutrition greatly impedes India’s socio-economic development and potential to reduce poverty.
Now, we know what works:
The critical window of opportunity, when nutrition interventions offer children the best chance for survival and development to their full potential is girl’s adolescence, women’s pregnancy and children’s first two years of life. After the age of two, the window closes and the opportunity for the child is lost.
There are ten proven, high-impact interventions that can halve child undernutrition rates if delivered at national scale:
1. Timely initiation of breastfeeding within one hour of birth
2. Exclusive breastfeeding in the first six months of life
3. Timely introduction of complementary foods at six months
4. Age-appropriate foods for children six months to two years
5. Safe and hygienic complementary feeding practices
6. Full immunization and bi-annual vitamin A supplementation with deworming
7. Appropriate feeding for children during and after illness
8. Therapeutic feeding for children with severe acute malnutrition
9. Adequate nutrition and anemia control for adolescent girls
10. Adequate nutrition and anemia control for pregnant and breastfeeding mothers
What we can do:
A number of emergent economies have successfully addressed their nutrition challenge. China reduced child undernutrition by more than half (from 25% to 8%) between 1990 and 2002; Brazil reduced child undernutrition by 60 percent (from 18% to 7%) from 1975 to 1989; and Vietnam reduced child undernutrition by 40 percent (from 45% to 27%) between 1990 and 2006. Four lessons can be learned from these countries’ experience:
1. Leadership at the highest level ensured that priority is given to child nutrition outcomes, with large investments in nutrition interventions and poverty alleviation strategies in the context of rapid economic growth;
2. Targeted nutrition interventions to prevent and treat undernutrition as part of a continuum of care, particularly among the most vulnerable children and women;
3. Reliance on community-based primary health care as the delivery system to ensure high coverage with essential nutrition interventions for the youngest children, adolescent girls, and pregnant women;
4. Strong supervision, independent monitoring and evaluation, and knowledge management to provide the evidence base for timely and effective policy, program, and budgetary action.
Child nutrition; a national development priority. India can do it:
The universal delivery of this package of ten proven, high impact essential nutrition interventions will lead to an unprecedented reduction in child undernutrition.
Three windows of opportunity that are wide open and must be used to achieve this are: improvement of girl’s nutrition during adolescence, improvement of maternal nutrition during pregnancy and lactation, and improvement of children’s nutrition in the first two years of life.
India has the resources - financial and human - to scale up an inspirational national response to address the challenge of child undernutrition.
The prevention and treatment of child undernutrition in the first two years of life needs to become a national development priority.
A focus on women’s nutrition and their empowerment to make informed choices about the nutrition and well-being of their children will make of India a global leader.
Now is the time to combine the existing technical knowledge with the political will to change the lives of millions of children and women in India. India can do it and we stand ready to support the government in this endeavor, and unite for children.